Routine inspection·July 24, 2025

On 07/24/2025, Licensing Program Analyst (LPA) Triel Ellen Lindstrom arrived unannounced at the facility to conduct a required annual inspection. The LPA met with Designated Facility Administrator (DFA) Alexis Alvarez. The LPA introduced herself, explained the purpose of the visit, and conducted an interview with the Administrator. The DFA accompanied the LPA on a tour of the facility. The facility is a one story building that is licensed for forty-five residents. The facility had a hospice waiver for five. The census was thirty-five at the time of this inspection. The LPA toured the common areas, including gathering areas, dining rooms, and hallways. These areas were clean, uncluttered, decorated, and bright with natural light. The LPA observed that these areas were pest-free and odor-free. There was enough furniture to accommodate all residents for dining, as well as for spending time with visitors. The LPA toured the kitchen and interviewed the new Culinary Services Manager. Kitchen staff do a deep clean monthly. The kitchen was clean and free of grease, food debris, and spills. The facility had a seven day nonperishable and two day perishable supply of food. Staff took the temperature of food and drink for every meal and every day of the week to ensure food safety. Temperatures of refrigerators and freezer interiors were also logged daily and the ambient temperature monitored. The stove hood was last serviced on May 25, 2025 by AFS Fire1. The LPA observed resident bedrooms and bathrooms. The bedrooms were clean and had the required furniture in it. The bathrooms were also clean, odor-free, and had non-slip mats, grab bars, and modifications as needed to accommodate the rooms' residents. The LPA measured the temperature of the This is page 2 of the report. water in a resident bedroom and it measured at 118 degrees Fahrenheit. The LPA pushed the call button in a resident bathroom and a caregiver responded within four minutes. The LPA toured the Medication Room and interviewed a Med Tech. The facility used an electronic system for tracking medication and care plans. Resident medications were kept in a dedicated, locked room, and in a locked medicine cart when being passed. Medications were separated by resident and stored in their original bottles with intact labels. The Director of Nursing conducts monthly audits of residents' medications. Narcotics were kept in a separate locked area and logged in a binder on paper forms. The LPA toured the grounds. The walkways were free of obstruction. The front, side, and back yards had green grass and many shade trees. The LPA observed shaded seating areas and ornamental decor outside. The LPA interviewed the Maintenance Director. A company called B.I.C serviced the facility's fire suppression system on 07/23/2025, including its sprinkler system, smoke and carbon monoxide detectors, and fire alarms. The LPA observed a work order from 07/23/2025 that confirmed this service. The fire extinguishers are checked The LPA observed residents eating a meal, visiting with each other, and playing bingo. The LPA reviewed three resident files and three staff files. The resident and staff files were organized and contained the required documentation. The staff were First Aid trained and had criminal background clearances. The LPA requested that updated copies of these documents be submitted to Licensing. These documents can be sent to LPA at ellen.lindstrom@dss.ca.gov. (1) LIC 308 Designation of Facility Responsibility (2) Copy of a valid Administrator Certificate (3) LIC 610 Emergency Disaster Plan (4) Proof of Liability Insurance (5) LIC 500 Personnel Report (6) LIC 309 Administrative Organization As a result of this inspection, no deficiencies were cited. The facility was in compliance with California Code of Regulations (CCR), Title 22, Division 6. An exit interview was conducted with the DFA, to whom a copy of this LIC809 report was provided. Their signature below confirms receipt of this document.